[NRSKarenRN]

Donations of Texts, Journals Help Rebuild Iraq's Medical Library, Clinics

Cathy Tokarski
http://www.medscape.com/viewarticle/484446?src=mp

July 29, 2004 (updated Aug. 3, 2004) — Many months or even years are likely to pass before the invasion and rebuilding of Iraq led by the United States is deemed a success or failure. But a volunteer effort to provide Iraq's largest medical school library with up-to-date textbooks and journals already can be judged an unqualified victory.

Organizers of the effort say the donations of nearly 100,000 medical textbooks and journals to the library of Tikrit University College of Medicine, as well as to other medical schools, hospitals, and clinics in Iraq from individuals, medical schools, medical libraries, and publishing companies in the U.S., England, Canada, and other English-speaking countries have exceeded their wildest expectations. The outpouring was prompted by an article and request for donations that appeared on the Medscape Nurses Web site in August 2003.

"Even if I smoked pot, I wouldn't have hallucinated that it would have turned out this way," joked retired Col. David Gifford, MD, a physician at Darnall Army Community Hospital in Fort Hood, Texas, who spearheaded the effort.

Working in conjunction with Army Captain Alex Garza, MD, MPH, who was stationed in Tikrit through early 2004, and Susan Yox, RN, EdD, editor of Medscape Nurses, Dr. Gifford said the response underscores Americans' humanitarian nature and their desire to share current medical knowledge with others. "It's an extension of the way the American people give to others," he said.

And Medscape's Web-savvy readers found a ready outlet for their desire to help that they can easily pass along to others, Dr. Yox added. "One of the great things about Medscape is that people can find out about these efforts, and they pick up on it and make it their project," she said.

A former medical school professor, Dr. Gifford learned of the dismal conditions at the medical college's library last May from a colleague there who kept a journal detailing the Army's efforts to rebuild the Iraqi medical infrastructure. Medical textbooks were scarce, and the journals the library maintained were typically 10 to 15 years old, with many articles just photocopies of originals.

"I thought, 'Why in God's name can't we get volunteers to provide these things?' It's great PR and it's doing the right thing," Dr. Gifford recalled in an interview with Medscape.

His enthusiasm was not shared initially, however.

Various medical publishers and distributors he contacted "must have viewed me as a crank" when presented with the idea of donating textbooks to Iraq, Dr. Gifford said. "Their universal response was, 'It sounds interesting — we'll get back to you.' Of course I heard nothing."

A similar but more disappointing response came from the U.S. Defense Department's Assistant Secretary of Defense for Health Affairs, whose office did not respond to Dr. Gifford's request for donations from the military's medical school in Bethesda, Maryland. Dr. Gifford had served on the medical school's faculty while at Walter Reed Army Medical Center from 1999 to 2001.

Grumbling but unwilling to call it quits, Dr. Gifford picked up a copy of Scientific American Medicine off his bookshelf, and contacted the publisher, WebMD (which owns Medscape). Within 20 minutes, he received a return call from Dr. Yox, whose widely read Nurses site had posted an article in early 2002 featuring an Army nurse serving in Afghanistan that asked readers to consider donating medical and nursing books, journals, and supplies to medical facilities there.

The three-month effort to help medical personnel in Afghanistan resulted in donations of 4,250 books, 3,550 journals, assorted videotapes and cassettes, as well as basic medical supplies, such as scrubs, stethoscopes, and blood pressure cuffs, Dr. Yox recalled. The response by individuals and companies was "pretty amazing," she said, convincing her that a request for assistance in the effort to rebuild the Iraqi medical library could generate a similar outpouring.

That request appeared in the article prepared by Dr. Garza, who was the Army's Public Health Team Chief for the 4th Infantry Division in Tikrit through February 2004. Dr. Gifford's son, Major Mark Gifford, a medical planner in Iraq, put the two physicians in touch.

Now back home in Kansas City, Missouri, working as an emergency room physician, Dr. Garza shared Dr. Gifford's belief that bringing Tikrit's medical library up to current standards was a wise move, both in the short and long term.

"I thought this was one area where we could have a legitimate, big impact, and it would be relatively easy," Dr. Garza recalled. Creating a medical library that allowed students to learn how Western physicians were treating various illnesses and diseases could help far more people than, for example, installing a new MRI machine, he said. "If you wanted to help the whole community, and the medical system as a whole, the best way to do that was through education.

Responses came pouring in just one week after his article posted on Medscape on Aug. 14, 2003. "I got a flood of emails that completely jammed up my mailbox" from individuals interested in everything from donating journals and textbooks to volunteering their services, Dr. Garza said.

Dr. Gifford witnessed a similarly enthusiastic, but more visible, response with donated material arriving at his office at the Army hospital in Fort Hood. "I thought individual donors would go to the post office and mail packages overseas," he said. But as hospital staff began to deliver the donated shipments of journals, "I realized I couldn't suck up the cost — one shipment was 400 pounds, and I had already spent $100 to ship two donations separately."

Working his military contacts, Dr. Gifford got in touch with Air Force officials, who allowed him to use "space available shipping" on flights departing from Dover Air Force Base in Delaware. A shipment from WebMD of 1,000 copies each of Scientific American Medicine and ACS Surgery, weighing approximately 10,000 pounds and valued at $429,000, was transported from New York to Baghdad via an Air Force flight from Dover, he said.

Concerned about "wearing out his welcome" at Dover, Dr. Gifford also located willing partners at the Army's Fort Bragg, North Carolina, base, who have helped him ship a donation of about 10,000 books from a student organization at Mount Sinai Hospital in New York City, and another large donation from Eastern Virginia Medical School in Norfolk. "Now, I'm wrestling with a donation of four or five skids of medical journals from Merck in Canada," he said, not unhappily.

Additional assistance in paying for the transport of large donations has come from Elsevier, a Philadelphia, Pennsylvania–based medical publishing company, which underwrote the cost of shipments of approximately 2,000 textbooks collected by students at the University of Tennessee Medical School, according to Dr. Yox. "Lots of people have just quietly done things" to make sure the donations got to where they needed to go, she said.

As shipments arrived in Tikrit, they were sorted into basic science and clinical categories for the medical library, with duplicate copies sent to the hospital in nearby Sumara, Dr. Garza said. Handbooks for obstetrics/gynecology and pediatrics were sent to clinics around the country, where staff often have little or no access to basic information.

More textbooks and journals were also distributed at the first-ever medical conference of American and Iraqi physicians, convened in the Salah-al-Din province (the area surrounding Tikirit) in January, Dr. Garza said. "We took a bunch of books and journals and handed them out there. We thought that would be appropriate."

The gesture, and the medical literature, did not go unappreciated, Dr. Garza noted. "For all the troubles physicians have had, they're still very devoted to their craft. It was clearly evident when we took the reading materials to them, they would just eat that stuff up — they thought it was incredible that we got all of these journals," he said.

Donations of some 2,000 nursing textbooks and 10,000 journals are also being distributed at the local nursing school in Tikrit, according to Captain Donna M. Kentley, MHP, a physician's assistant assigned to the public health team formerly headed by Dr. Garza. Because the university-educated nursing graduates speak English and typically serve as instructors at the Tikrit nursing school, "the books and journals that were donated there will be of great use for them in preparing their classes," Captain Kentley wrote in a recent email from Iraq.

But nursing education remains far behind U.S. standards, Captain Kentley reported, with only 300 baccalaureate-educated nurses in the country. A 10-year plan to improve nursing education and training is now underway, with a primary focus on Baghdad. "It is a very slow process, as we are dealing with a culture that hasn't changed very much over time," she writes.

Despite the overwhelming lack of resources and political and cultural barriers that have thwarted their progress, Iraqi physicians and nurses remain committed to their profession and are eager to make up for lost time.

"The majority of physicians we talked to are very happy to be physicians, they want to do their jobs, and want to know about the latest advances in medicine," Dr. Garza said. "They were frustrated because...medical and pharmaceutical supplies were in such short supply or hard for them to get, but they still had that eagerness to try to improve their healthcare delivery system."

"The gratitude from the Iraqi healthcare professionals is overwhelming," according to Captain Kentley, adding that shipments of donated materials are continuing to arrive in late July and others are en route. "They are now starting to see the window to the outside world that has been kept from them for so long and they are grateful for what the Americans have done for them," she writes.

Opening that window, added Dr. Garza, "was a team effort" every step of the way.

Related Links

A Call for Help: Medical Books, Journals, and Supplies Needed in Afghanistan
Help for the Healthcare System in Iraq
Nursing in Iraq: Starting From Scratch